outcomes of a leadership intervention in long-term care q-3 tuesday, october 9, 2007 susan gilster,...

Outcomes of a Leadership Intervention in Long-Term Care

Q-3Tuesday, October 9, 2007

Susan Gilster, PhDJennifer Dalessandro, BS

Alois Alzheimer Centerwww.alois.com

[email protected]

http://www.alois.com/

mailto:[email protected]

Susan D. Gilster, PhDSusan D. Gilster, PhD

Our Belief:Our Belief:

Creating a successful workforce takes an Creating a successful workforce takes an organizational approach, thus it is leadership organizational approach, thus it is leadership drivendriven

Leadership is key to the success of any Leadership is key to the success of any organization. It is critical in the recruitment and organization. It is critical in the recruitment and retention of staff. retention of staff.

Leadership is in the hands of the person who is at Leadership is in the hands of the person who is at the top, the administrator, executive director, CEO, the top, the administrator, executive director, CEO, etc. It will not happen without their blessing. etc. It will not happen without their blessing.


Leaders in Long-Term CareLeaders in Long-Term Care

The Administrator The Administrator isis the one who the one who leads the organization – license on leads the organization – license on the line.the line.

Like it or not, they determine what Like it or not, they determine what happens in the facility.happens in the facility.

While the President or CEO of a While the President or CEO of a corporation might set the agenda, corporation might set the agenda, the Administrator puts the plan into the Administrator puts the plan into operation-OR NOToperation-OR NOT


Leadership Model Leadership Model

Qualitative, historical case studyQualitative, historical case study Extensive review of literature-Extensive review of literature-

business, no health care leadership business, no health care leadership literature in LTC literature in LTC

First leadership literature in 2002First leadership literature in 2002 Grounded in business literatureGrounded in business literature Identified important organizational Identified important organizational

elements elements


Leadership ModelLeadership Model

Long-term care administrator researchLong-term care administrator research Popular leadership concepts – Administrator Popular leadership concepts – Administrator

perspectives- 2004perspectives- 2004 Knew what they should be doing but did not Knew what they should be doing but did not

know HOWknow HOW

Consistent with research, National Quality Consistent with research, National Quality Award Criteria and Baldridge CriteriaAward Criteria and Baldridge Criteria


Service Oriented Leadership Service Oriented Leadership ModelModel

S.E.R.V.I.C.E.S.E.R.V.I.C.E. S S ervice (Greenleaf, Blanchard, Kouzes…)ervice (Greenleaf, Blanchard, Kouzes…) E E ducation (Deming, Crosby…..)ducation (Deming, Crosby…..) R R espect (Annison, Longest…)espect (Annison, Longest…) V V ision (Senge, Kouzes…)ision (Senge, Kouzes…) I I nclusion (Collins, Wheatley, Autry…)nclusion (Collins, Wheatley, Autry…) C C ommunication (Helgesen, Goleman……..)ommunication (Helgesen, Goleman……..) E E nrichment (Conger, Bennis, DuPree, nrichment (Conger, Bennis, DuPree,

Jawarski…..)Jawarski…..)


S.E.R.V.I.C.E. Leadership S.E.R.V.I.C.E. Leadership ModelModel

Service: Using all gifts & talents to Service: Using all gifts & talents to serve others & the visionserve others & the vision

Working for a purpose higher than self; serving others rather than being served; Working for a purpose higher than self; serving others rather than being served; being a servant, teacher, coach mentor; living by the Golden Rule; valuing the being a servant, teacher, coach mentor; living by the Golden Rule; valuing the empowerment & growth of others; taking personal ownership of work, caring empowerment & growth of others; taking personal ownership of work, caring about othersabout others

Education: Valuing & promoting Education: Valuing & promoting education & learning as a lifelong education & learning as a lifelong process for self and othersprocess for self and others

Being skilled, knowledgeable, the best for self/others; providing mentoring/role Being skilled, knowledgeable, the best for self/others; providing mentoring/role modeling; preparing staff for their roles; facilitating ongoing modeling; preparing staff for their roles; facilitating ongoing personal/professional education/support; challenging/encouraging others to personal/professional education/support; challenging/encouraging others to achieve; choosing education over discipline; collective learningachieve; choosing education over discipline; collective learning

Respect: Valuing & promoting Respect: Valuing & promoting respect, dignity & personhood of respect, dignity & personhood of othersothers

Establishing respect as core value; conducting discussions in private space, Establishing respect as core value; conducting discussions in private space, maintaining fair, consistent practices; treating all with respect; maintaining fair, consistent practices; treating all with respect; recognizing/celebrating accomplishments; giving creditrecognizing/celebrating accomplishments; giving credit

Vision: Creating a total picture of Vision: Creating a total picture of what you dream of developing what you dream of developing including guiding principles & including guiding principles & valuesvalues

Creating vision, mission & philosophy, being the best; establishing guiding Creating vision, mission & philosophy, being the best; establishing guiding principles, values; looking at the whole vs. part; long-term & short-term planning principles, values; looking at the whole vs. part; long-term & short-term planning vs. reacting to daily crisis; keeping the vision alive.vs. reacting to daily crisis; keeping the vision alive.

Inclusion: Involving everyone as a Inclusion: Involving everyone as a partner in the evolution & partner in the evolution & progression of the projectprogression of the project

Respecting, appreciating, recognizing input/contribution of others; staying Respecting, appreciating, recognizing input/contribution of others; staying connected to staff; seeking right persons/trusting them; communicating connected to staff; seeking right persons/trusting them; communicating expectations/requiring accountability; creating formal & informal dialogueexpectations/requiring accountability; creating formal & informal dialogue

Communication: establishing an Communication: establishing an environment involving the active environment involving the active interchange of ideas & interchange of ideas & expectationsexpectations

Communicating expectations/information to staff; remaining open and listening Communicating expectations/information to staff; remaining open and listening to comments, concerns/suggestions; creating opportunities to dialogue re: new to comments, concerns/suggestions; creating opportunities to dialogue re: new programs/innovations/solutions; surveying for initiativesprograms/innovations/solutions; surveying for initiatives

Enrichment: Generating self Enrichment: Generating self knowledge & conducting ongoing knowledge & conducting ongoing work with your self/spiritwork with your self/spirit

Knowing who you and/what makes you tick; performing with integrity, Knowing who you and/what makes you tick; performing with integrity, maintaining personal values; listening to inner voice/intuition; being open, maintaining personal values; listening to inner voice/intuition; being open, having confidence/trusting in own ability; taking risks, creating “balance” in your having confidence/trusting in own ability; taking risks, creating “balance” in your life, maintaining self through contemplation, reflectionlife, maintaining self through contemplation, reflection


ResearchResearch

Consulting in Continuing Care CommunityConsulting in Continuing Care Community Facility in troubleFacility in trouble Administrator turnover – 1-2 yearsAdministrator turnover – 1-2 years Attractive building and good location Attractive building and good location

(1987)(1987) Census – up and downCensus – up and down High staff turnoverHigh staff turnover High utilization of agency staffHigh utilization of agency staff


Research MethodResearch Method

Involved in Administrator selection Involved in Administrator selection prior to studyprior to study

Identified an Administrator with Identified an Administrator with SERVICE orientationSERVICE orientation

Administrator familiar with SERVICE Administrator familiar with SERVICE model but was not given instruction model but was not given instruction on how or what to implementon how or what to implement


Research MethodResearch Method

Staff and family satisfaction surveys Staff and family satisfaction surveys conducted prior to announcement of the conducted prior to announcement of the hiring of new administratorhiring of new administrator

Staff surveys were conducted at baseline, 3 Staff surveys were conducted at baseline, 3 & 6 months, and at 1 year& 6 months, and at 1 year

Staff surveys – anonymous, placed in Staff surveys – anonymous, placed in sealed boxsealed box

Staff listed department only-no namesStaff listed department only-no names Family surveys at baseline-to PO Box Family surveys at baseline-to PO Box


Staff Survey InstrumentStaff Survey Instrument

Consistent survey each sessionConsistent survey each session Consisted of:Consisted of:

Assigned work (10)Assigned work (10) Work conditions (8)Work conditions (8) Facility policies & procedures (9)Facility policies & procedures (9) Relationships with others (16)Relationships with others (16) Training and education (5)Training and education (5) Overall satisfaction and referral (5)Overall satisfaction and referral (5) Open ended questions (6)Open ended questions (6)


ResultsResults

Return/Participation Rates:Return/Participation Rates:

Staff – All departmentsStaff – All departments 77% (n=118) at baseline 77% (n=118) at baseline (5 days)(5 days) 78% (n=119) at 3 months (2 days)78% (n=119) at 3 months (2 days) 70% (n=116) at 6 months (2 days)70% (n=116) at 6 months (2 days) 75% (n=119) at 1 year (2 days)75% (n=119) at 1 year (2 days)

Families – 63% (n=116) at baselineFamilies – 63% (n=116) at baseline


About Your Assigned Work About Your Assigned Work (10)(10)

About your assigned work:About your assigned work: Very Very HappyHappy

HappyHappy UnhappUnhappyy

Very Very UnhappyUnhappy

Amount of responsibility…Amount of responsibility…

3.08*3.08*2.912.91

Ability to make decisions…Ability to make decisions… 3.093.09

3.20*3.20*

Understanding of my part in care…Understanding of my part in care… 3.263.26

3.35*3.35*

What is expected of me…What is expected of me… 3.113.11

3.21*3.21*


About Your Assigned Work About Your Assigned Work (10)(10)

About your assigned work:About your assigned work: Very Very HappyHappy

HappyHappy UnhappUnhappyy

Very Very UnhappyUnhappy

My part in defining My part in defining purpose/direction…purpose/direction… 3.05*3.05*

2.912.91

Importance of work…Importance of work… 3.373.37

3.43*3.43*

Ability to use trainingAbility to use training 3.283.28

3.34*3.34*

Ability to use talents…Ability to use talents… 3.263.26

3.38*3.38*

Ability to do different things…Ability to do different things… 3.133.13

3.21*3.21*

Perform to professional Perform to professional standards…standards…

3.013.01

3.30*3.30*


Assigned Work CommentsAssigned Work Comments

Baseline Comments:Baseline Comments: Themes - Lack of respect and communicationThemes - Lack of respect and communication ““I’m just a clerk”I’m just a clerk” ““We are not heard a lot of the time”We are not heard a lot of the time”

12 Month Comments:12 Month Comments: Themes – Responsibilities and communicationThemes – Responsibilities and communication ““I feel as if I am given room to do my job”I feel as if I am given room to do my job” ““It’s a big improvement since last year”It’s a big improvement since last year”


About Your Work Conditions About Your Work Conditions (8)(8)

About your work conditions:About your work conditions: Very Very HappyHappy

HappyHappy UnhappyUnhappy Very Very UnhappyUnhappy

Amount of work assigned…Amount of work assigned… 2.562.56

2.58*2.58*

Number of staff assigned…Number of staff assigned… 2.442.44

2.51*2.51*

Time to complete work…Time to complete work… 2.742.74

2.88*2.88*

Recognition I receive…Recognition I receive… 2.442.44

2.73*2.73*


About Your Work Conditions About Your Work Conditions (8)(8)

About your work conditions:About your work conditions: Very Very HappyHappy


Help/direction…Help/direction… 2.742.74

2.90*2.90*

Participate in care decisions…Participate in care decisions… 2.862.86

2.95*2.95*

Equipment/supplies…Equipment/supplies… 2.732.73

2.87*2.87*

Feelings of safety…Feelings of safety… 3.033.03

3.11*3.11*


About Facility About Facility Policies/Procedures (9)Policies/Procedures (9)

About facility policies/procedures…About facility policies/procedures… Very Very HappyHappy


Chance to move up…Chance to move up… 2.652.65

2.68*2.68*

Uniform allowance…Uniform allowance… 2.802.80

2.79*2.79*

Wages/pay…Wages/pay… 2.442.44

2.51*2.51*

Profit Sharing plan…Profit Sharing plan… 2.752.75

2.78*2.78*

Job is secure…Job is secure… 2.512.51

2.54*2.54*


About Facility About Facility Policies/Procedures (9)Policies/Procedures (9)

About facility policies/procedures…About facility policies/procedures… Very Very HappyHappy


Personal time off…Personal time off… 2.712.71

2.79*2.79*

Yearly review process…Yearly review process… 2.722.72

2.71*2.71*

Disciplinary process…Disciplinary process… 2.532.53

2.66*2.66*

How well communicated…How well communicated… 2.462.46

2.58*2.58*


Policy/Procedure CommentsPolicy/Procedure Comments

Baseline Comments:Baseline Comments: ““HR is too one-sided when you disagree with mg”HR is too one-sided when you disagree with mg” Applies to a select few, all rules are not for everyone.”Applies to a select few, all rules are not for everyone.” ““Wondering everyday if I will get that phone call – fired Wondering everyday if I will get that phone call – fired

with no just cause”with no just cause”

12 Month Comments:12 Month Comments: ““Communication is still an issue at time, but I feel Communication is still an issue at time, but I feel

attempts are being made to improve things”attempts are being made to improve things” ““Not unhappy with policy communication but I think we Not unhappy with policy communication but I think we

could do better”could do better” ““Uncertain with job security – with the loss of long Uncertain with job security – with the loss of long

term employees”term employees”


About Your Relationship with About Your Relationship with Others (15)Others (15)

About your relationship with About your relationship with others…others…

Very Very HappyHappy


Respect from my departmentRespect from my department 3.063.06

3.19*3.19*

Respect from other Respect from other departments…departments… 3.05*3.05*

2.972.97

Respect from my shift…Respect from my shift… 3.093.09

3.16*3.16*

Other staff listen…Other staff listen… 2.862.86

2.96*2.96*






Respect from supervisor…Respect from supervisor…

3.10*3.10*2.902.90

Respect from families…Respect from families… 3.423.42

3.33*3.33*

Families listen…Families listen… 3.353.35

3.26*3.26*

Compliments from supervisor…Compliments from supervisor…

3.02*3.02*2.732.73






Relationship with residents…Relationship with residents… 3.713.71

3.59*3.59*

Feeling part of team…Feeling part of team…

3.13*3.13*2.972.97

Feeling others care…Feeling others care…

3.05*3.05*2.912.91

Emotional support…Emotional support… 2.822.82

2.99*2.99*






Availability of administrators…Availability of administrators… 2.602.60

2.95*2.95*

Availability of department Availability of department heads…heads…

2.642.64

2.95*2.95*

Administrator openness…Administrator openness… 2.422.42

2.87*2.87*


Relationship with OthersRelationship with Others

Baseline Comments:Baseline Comments: ““Supervisors don’t listen to aids even though your right…Supervisors don’t listen to aids even though your right…

nothing is right but what they say”nothing is right but what they say” ““We never got to hear or see the Administrator.”We never got to hear or see the Administrator.” ““I don’t even know who the Administrator is.”I don’t even know who the Administrator is.”

12 Month Comments:12 Month Comments: ““The teamwork and communication between staff is very The teamwork and communication between staff is very

good. Administration is very friendly and supportive and good. Administration is very friendly and supportive and encouraging”encouraging”

The relationship between all staff is so much better. I The relationship between all staff is so much better. I don’t feel the stress when coming to work each day. don’t feel the stress when coming to work each day. What a change!”What a change!”


About Your Training/Education About Your Training/Education (5)(5)

About your training/education…About your training/education… Very Very HappyHappy


Job preparation/orientation…Job preparation/orientation… 2.762.76

2.83*2.83*

Regular staff meetings…Regular staff meetings… 2.672.67

2.78*2.78*

Chance to learn from others…Chance to learn from others…

3.00*3.00*2.872.87


About Your Training/Education About Your Training/Education (5)(5)

About your training/education…About your training/education… Very Very HappyHappy


Inservices/ongoing training…Inservices/ongoing training… 2.772.77

2.89*2.89*

Chance to learn new things…Chance to learn new things… 2.782.78

2.97*2.97*


Training/Education Training/Education CommentsComments

Baseline Comments:Baseline Comments: Lack of communication, disorganization when education Lack of communication, disorganization when education

is offeredis offered ““I’m just a clerk”I’m just a clerk” ““Only one good day”Only one good day”

12 Month Comments:12 Month Comments: ““Going forward. Much better than a year ago.”Going forward. Much better than a year ago.” When I started the orientation was almost non-When I started the orientation was almost non-

existent. Now the employees get a wonderful existent. Now the employees get a wonderful orientationorientation.”.”

The P.I.E. program is great!”The P.I.E. program is great!”


Overall Statements (5)Overall Statements (5)

StatementStatement Strongly Strongly AgreeAgree

AgreeAgree DisagreeDisagree Strongly Strongly DisagreeDisagree

Satisfied with my job…Satisfied with my job…

3.09*3.09*2.972.97

Proud of work…Proud of work… 3.633.63

3.57*3.57*

Making a difference…Making a difference… 3.553.55

3.55*3.55*


Overall Statements (5)Overall Statements (5)

StatementStatement Strongly Strongly AgreeAgree

AgreeAgree DisagreeDisagree Strongly Strongly DisagreeDisagree

Would advise a friend to Would advise a friend to apply…apply…

2.892.89

2.99*2.99*

Think of changing jobs…Think of changing jobs… 2.462.46

2.26*2.26*


What I want most from my What I want most from my job…job…

Baseline and 12 month themes: Baseline and 12 month themes: Respect, appreciation, fairness, Respect, appreciation, fairness,

serving others, education, serving others, education, communication, pay, health benefits, communication, pay, health benefits, teamwork, a voice, support when teamwork, a voice, support when someone dies.someone dies.


Additional CommentsAdditional Comments

Most started with a positive commentMost started with a positive comment ““There is a wonderful feeling here…a great ‘vibe’.”There is a wonderful feeling here…a great ‘vibe’.” ““I feel ___ have come along some but we’re not I feel ___ have come along some but we’re not

there yet”there yet” ““I believe that many positive changes and strides I believe that many positive changes and strides

have been made within the company.”have been made within the company.”

““I would like to hear results”I would like to hear results”

““It is great to do research if it effects change”It is great to do research if it effects change”


If I could do anything in the If I could do anything in the world I would…world I would…

Over 50% would stay in healthcare, but Over 50% would stay in healthcare, but perhaps in a different role/capacity.perhaps in a different role/capacity.

Cruise director, talk show hostCruise director, talk show host Open a businessOpen a business Write a bookWrite a book Fashion designerFashion designer Professional bass fishermanProfessional bass fisherman


Family SurveyFamily Survey

63% participation (n=116)63% participation (n=116)

Overall, families satisfiedOverall, families satisfied

Majority answered in “Agree” Majority answered in “Agree” categorycategory


InterventionsInterventions

Administrator had no instruction or Administrator had no instruction or advice from researchers – complete advice from researchers – complete freedom.freedom.

Interventions were recorded by the Interventions were recorded by the administrator over the 12 month administrator over the 12 month period.period.


Specific InterventionsSpecific Interventions

Service, Vision/Mission, Education, Service, Vision/Mission, Education, Communication, Inclusion, RespectCommunication, Inclusion, Respect

Resident Centered Culture-top/modelResident Centered Culture-top/model Stopped smoking at front entranceStopped smoking at front entrance Grievance CommitteesGrievance Committees Satisfaction surveysSatisfaction surveys More selective dining for residentsMore selective dining for residents Dept Mg/Nursing offices in resident areasDept Mg/Nursing offices in resident areas Routine staff meetings-eventually all shiftsRoutine staff meetings-eventually all shifts Multiple mechanisms to communicateMultiple mechanisms to communicate


One step forward, TEN steps One step forward, TEN steps back?back?

At month 10 of intervention, At month 10 of intervention, “corporate” wants involved…“corporate” wants involved… Employee complaintsEmployee complaints Long-term employee resignedLong-term employee resigned Manager resigned but told to leave, not Manager resigned but told to leave, not

necessary to work out 30 day noticenecessary to work out 30 day notice Corporate Director wants to interview staffCorporate Director wants to interview staff Want to view staff surveys and resultsWant to view staff surveys and results


One step forward, TEN steps One step forward, TEN steps back?back?

Meeting held with Administrator, Meeting held with Administrator, Research, and Corporate TeamResearch, and Corporate Team Don’t undo all progress to dateDon’t undo all progress to date Don’t undermine AdministratorDon’t undermine Administrator Integrity of research, promise of Integrity of research, promise of

confidentialityconfidentiality If you always do what you have always If you always do what you have always

done you will always get what you always done you will always get what you always gotgot


MAKE OR BREAKMAKE OR BREAKMomentMoment

Huge turning point in future of facilityHuge turning point in future of facility

Prevent history from repeating itselfPrevent history from repeating itself

12 month results are proof that 12 month results are proof that success in around the corner if we success in around the corner if we stay the coursestay the course


Census, Financial, Agency & Census, Financial, Agency & StaffStaff

Changes in past 12-15 months:Changes in past 12-15 months:

Moderate Increase in censusModerate Increase in census

Small drop in agency utilizationSmall drop in agency utilization


Census, Financial, Agency & Census, Financial, Agency & StaffStaff

Baseline - Most critical was the hiring/turnoverBaseline - Most critical was the hiring/turnover Hiring 8-24/month, average of 16 per monthHiring 8-24/month, average of 16 per month Terminating 10-19/month, average 14 per monthTerminating 10-19/month, average 14 per month $5,000 per employee = $853,000 per year$5,000 per employee = $853,000 per year

12 Months12 Months Hiring decreased, average 13/month from a high Hiring decreased, average 13/month from a high

average of 24/monthaverage of 24/month Terminations decreased, average 12/month from a Terminations decreased, average 12/month from a

high average of 17/monthhigh average of 17/month


Changes in 18 monthsChanges in 18 months

Turnover in the Turnover in the single digitssingle digits

Agency utilization-rareAgency utilization-rare

Census-now fullCensus-now full

Financials-greatly improvedFinancials-greatly improved


ConclusionsConclusions

In desire to transform the long-term care In desire to transform the long-term care industry, leadership cannot be overlookedindustry, leadership cannot be overlooked

Leaders need to be facilitators - or get out Leaders need to be facilitators - or get out

of the wayof the way Transformation and culture change require Transformation and culture change require

an organizational approachan organizational approach Answer is not found in a single program or Answer is not found in a single program or

departmentdepartment


ConclusionConclusion

It takes time - culture transformation It takes time - culture transformation will not happen overnightwill not happen overnight

Culture change is about people Culture change is about people change - not items or physical change - not items or physical environment aloneenvironment alone

We don’t have a culture crisis - we We don’t have a culture crisis - we have a leadership crisishave a leadership crisis


RecommendationsRecommendations

Area for further study/researchArea for further study/research Research on the impact that Research on the impact that

leadership plays in long-term careleadership plays in long-term care Education and training for long-term Education and training for long-term

care administrators and managers in care administrators and managers in leadership and organizational leadership and organizational developmentdevelopment

Why is This Important?

outcomes of a leadership intervention in long-term care q-3 tuesday, october 9, 2007 susan gilster,...

Documents

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